Dr. Thomas Sterry – Thomas P. Sterry, MDhttps://www.drsterry.com/blog
Cosmetic Plastic Surgery in New YorkWed, 20 Sep 2017 23:51:17 +0000en-UShourly1Spring Is The Season For A Tummy Tuck In NYChttps://www.drsterry.com/blog/body-contouring/tummy-tuck-in-nyc/
https://www.drsterry.com/blog/body-contouring/tummy-tuck-in-nyc/#commentsThu, 24 Mar 2016 14:39:59 +0000http://www.drsterry.com/blog/?p=1052During the wintertime we are all covered up here in New York City. The days are short and it’s hard to remain active, so many of us get cozy on the couch with comfort foods. When spring rolls around and we finally stand up to take off our sweaters it can be a little shocking to see what’s happened to our bodies during the last few months. That’s why Spring is such a popular time for body contouring procedures like laser lipo or a tummy tuck in New York. Fortunately, there is still time to get it together. Hit the … Continue reading

During the wintertime we are all covered up here in New York City. The days are short and it’s hard to remain active, so many of us get cozy on the couch with comfort foods. When spring rolls around and we finally stand up to take off our sweaters it can be a little shocking to see what’s happened to our bodies during the last few months. That’s why Spring is such a popular time for body contouring procedures like laser lipo or a tummy tuck in New York. Fortunately, there is still time to get it together. Hit the gym, watch your diet, and if necessary, my office can help…quite a bit.

Why Get A Tummy Tuck?

A tummy tuck can be the key ingredient for body contouring, but in contrast to liposuction (where the main purpose is to remove excess skin, NOT to remove fat per se’. Fat is removed, of course, but that is not the focus of the procedure. The idea with a tummy tuck is to remove excess skin from the lower belly and tighten the abdominal muscles. A tummy tuck is most commonly done for women after giving birth because their entire abdominal wall has been sort of “stretched out”, and this procedure can tighten everything back up again.

While the results from a tummy tuck can be much more dramatic than that for laser lipo, the recovery is a bit more prolonged. We have seen patients with desk jobs get back to work in as few as 8 days, but typically it is more like 2 weeks. Occasionally patients will need up to 3 weeks before they are truly feeling like themselves again.

How Does Laser Lipo Help Your Contour?

Laser lipo (e.g. Smartlipo) is an advanced form of liposuction that uses the help of a laser passed under the skin in the subcutaneous fat to melt it and make it easier to remove. In some areas of the body it can also help to tighten the skin. I see skin tightening in the upper arms and the neck regularly. I also think there is improvement in the torso skin, but I’m not comfortable actually saying that the skin is “tighter”. These procedures can be done under local anesthetic with the patient completely awake, but sedation is available for those who request it.

Laser Lipo Results

Recovery from laser lipo typically requires a weekend of what we call “down time” before patients are ready to return to work. There is lingering swelling and soreness for a few weeks, but the time needed to get over the procedure and get back to work is typically just a couple of days. The swelling can linger depending on the area we are working on. Six weeks after the procedures patients are normally very happy and then we tell them they only have about 75% of their result with more improvement to come. At 3 months (as in the photo above), I consider the swelling essentially gone and what they see is what they are going to get.

Spring Is A Common Time To Get A Tummy Tuck or Laser Lipo NYC

The point I’m trying to make with this blog is that the results of plastic surgery procedures are not always apparent right away. So, if you want to look good at the beach this summer, it would be wise to look into your laser liposuction or tummy tuck early in the year.

]]>https://www.drsterry.com/blog/body-contouring/tummy-tuck-in-nyc/feed/2Lip Augmentation: Fillers vs. Fat Transferhttps://www.drsterry.com/blog/plastic-surgery/lip-augmentation-fillers-fat/
https://www.drsterry.com/blog/plastic-surgery/lip-augmentation-fillers-fat/#respondTue, 16 Feb 2016 18:42:58 +0000http://www.drsterry.com/blog/?p=1043Many of the women who walk into my New York plastic surgery practice come in seeking lip augmentation with a beautiful, natural, fuller look. The key word is “natural” as they immediately point out that they do not want the “duck-faced” or “sausage-shaped” lips of the past. Over the past couple of years, I have refined my technique so patients get shape and contour along the entire length of the lips and mouth area, not just adding volume in a straight line. This results in a much more natural look. There are 2 basic ways to enhance the lip area: … Continue reading

]]>Many of the women who walk into my New York plastic surgery practice come in seeking lip augmentation with a beautiful, natural, fuller look. The key word is “natural” as they immediately point out that they do not want the “duck-faced” or “sausage-shaped” lips of the past.

Nice lips have many contours and shouldn’t look like sausages across the mouth

Over the past couple of years, I have refined my technique so patients get shape and contour along the entire length of the lips and mouth area, not just adding volume in a straight line. This results in a much more natural look.

There are 2 basic ways to enhance the lip area: lip fillers from a box such as JUVÉDERM® or by fat transfer. Fat transfer involves doing a little liposuction from one area and transferring the extracted fat to the mouth. As we age, we lose facial volume, and this loss results in cheek drooping and wrinkles around the mouth. Both lip fillers and fat transfer work to offset this loss around the lips.

Lip enhancement should be done with good taste and shape in mind. It is not simply a matter of making them “bigger”.

Using Fillers

In the non-surgical option of lip enhancement, I have started treating the whole mouth to try to create a more natural result. Injectable fillers are generally the best way to treat superficial lines around the mouth area and volumize the lips. Injections are done in a short office visit with some localized anesthesia, and the recovery is fairly quick with only mild redness and bruising.

In order to achieve a natural lip look, I personally like to inject the philtral columns (the vertical humps in the middle of the upper lip) and the superior lip tubercle (center of the upper lip) in the middle. Then on the bottom lip, I try to make 2 separate injections at the tubercles on the right and left of the midline such that the upper one fits between them. Patients get natural shape in many areas and avoid the sausage lip.

While JUVÉDERM may last up to a year in other areas, I find its longevity reduced dramatically in the lips. In fact, no matter which filler I use at my New York practice, the most we can hope for is 4 to 5 months in the lip region.

Check out my photo gallery to see some examples of lip augmentation with JUVÉDERM.

Using Fat

Fat transfer is a surgical procedure that requires liposuction from one area of the body and injecting that fat to enhance another. For lip enhancement, fat is harvested via liposuction and then injected back into the mouth area.

It is a permanent enhancement (provided that the fat lives) and is used to treat volume loss with replacement, not necessarily to correct fine lines. Fat transfer to improve volume often improves skin tone and texture around the mouth area, creating a natural look. Recovery from the fat transfer procedure is fairly mild with a few days of bruising and swelling. It is more expensive than fillers, but with a high success rate it is a great option for a permanent, natural solution.

The only downside to this technique is that sometimes the fat does not survive. It is a poorly understood phenomenon, but when the fat doesn’t survive, the patient gets almost no result. This is the main reason I don’t endorse the technique more steadfastly.

If you have been thinking about lip enhancement and are unsure about what procedure is right for you, please schedule a consultation where we can discuss your desires and find the solution that is right for you.

]]>https://www.drsterry.com/blog/plastic-surgery/lip-augmentation-fillers-fat/feed/0Breast Lift Scars: The Incision Decisionhttps://www.drsterry.com/blog/breast-surgery/breast-lift-scars-incision-decision/
https://www.drsterry.com/blog/breast-surgery/breast-lift-scars-incision-decision/#respondSat, 30 Jan 2016 15:36:54 +0000http://www.drsterry.com/blog/?p=943Designing Breast Lift Scars “Doctor, can I have the Lollipop incision, or are you going to give me those anchor breast lift scars?”. I get questions about breast lift scars a few times each week. It’s the kind of decision that we as plastic surgeons are constantly faced with. No woman wants to have scars on her breasts and we don’t want to make them any more than patients want to have them. However, this is strictly speaking a “Tailoring” issue. If there is too much skin we can’t make a nice, cosmetically pleasing, “tear drop” shaped breast. It’s really not a … Continue reading

Designing Breast Lift Scars

“Doctor, can I have the Lollipop incision, or are you going to give me those anchor breast lift scars?”. I get questions about breast lift scars a few times each week. It’s the kind of decision that we as plastic surgeons are constantly faced with. No woman wants to have scars on her breasts and we don’t want to make them any more than patients want to have them. However, this is strictly speaking a “Tailoring” issue. If there is too much skin we can’t make a nice, cosmetically pleasing, “tear drop” shaped breast. It’s really not a lot different than creating a seam in a dress or shirt. Sometimes we can’t get around it, or IF we do, we might end up with some excess skin hanging around that ruins the shape of the breast.

The Two Most Common Breast Lift Scars

In the world of breast lift surgery there are many techniques, but basically only two main styles of skin incision which create the breast lift scars we are referring to. As mentioned above, they are the “Lollipop Breast Lift Scar” shown below, and the “Anchor Breast Lift Scar“.

The “Lollipop” breast lift scars are located around the areola and down the center of the breast.

Both of these techniques can yield beautiful results if performed well on the right candidates. There have been many academic papers written that try to define specific parameters and dictate when either operation can be performed, but I think this is more of an artistic issue.

The “Anchor” breast lift technique can also yield good results and removes a lot of the excess skin that is sometimes present.

I don’t have any hard and fast rules about when I do either one, it’s more of a sense I get from the physical examination of each breast. The goal in my mind is to get the best cosmetic outcome possible, not necessarily to force the patients anatomy to conform to any particular surgical plan. Of course, the patient always has the final vote on which operation we do.

Visor Flap To Avoid The Vertical Scar

“Do I have to have that scar going down the middle of my breast?” The main scar people object to when they are considering a breast lift is the vertical line that is created below the nipple/areolar complex down to the bottom of the breast. Ironically, this is also the most helpful in creating a nicely shaped contour. However, there is an operation designed that does NOT use that incision. The “Visor” flap is rarely used and is only useful for women seeking Breast Reduction who have very large breasts where the nipple rests 7 cm (almost 3 inches) below the bottom of the breast crease. I tinkered with it a few times back in the early 2000’s, but I was never truly satisfied with the cosmetic outcomes. Furthermore, the number of people who fit the requirements is very small. This procedure has largely fallen by the waist side. My friend and colleague, Dr. Allan Parungao was more persistent than I and managed to get the operation to work with some very good success. I have one of his cases presented here:

The “Visor Flap” is a method of breast reduction that avoids vertical scars.

Understanding Breast Lift Surgery

I try to help patients make this choice by explaining the issues. I show them many before and after photos of other women, I draw diagrams, and show graphics that are typically used for teaching residents how these operations are done. Once the patient has a better understanding of their own personal anatomy and can verbalize what they want after the breast lift, then we can create a surgical plan. Rarely, I have to tell them I can’t deliver the results that they want based on the limitations that they put in place on size and or breast lift scar placement. If they are unrealistic about what plastic surgery can do for them, then it’s best that we don’t work together.

Lollipop breast lift with silicone implant augmentation is shown.

Breast Lift Training Is Sometimes A Factor

Some of these decisions are dependent on the training of the surgeon. There are “purists” who believe surgeons should ALWAYS do one technique or the other. I find that the words “always” and “never” are rarely the right answer on the exam… or in life. I was lucky to have trained during a time that both major incision styles were being used. It enables me to do either operation with proclivity. The only question is which one I think is best suited to the patient attached to the breasts in question.

]]>https://www.drsterry.com/blog/breast-surgery/breast-lift-scars-incision-decision/feed/0Kybella vs. Chin Liposuction: Running Neck and Neckhttps://www.drsterry.com/blog/facial-surgery/kybella-vs-chin-liposuction-running-neck-and-neck/
https://www.drsterry.com/blog/facial-surgery/kybella-vs-chin-liposuction-running-neck-and-neck/#respondSun, 03 Jan 2016 15:05:27 +0000http://www.drsterry.com/blog/?p=957Is Kybella Better Than Chin Liposuction? Kybella is the new FDA approved product for injection that melts the fat in your neck to remove the dreaded double chin. Studies performed by the company were very promising and we are seeing some nice improvements in our patients as well. The question that arises however, is whether or not Kybella will replace chin liposuction as the mainstay of treatment to create an elegant look in patients who are not ready for a neck lift. Neck or Chin Liposuction For Neck Contouring Neck liposuction (typically performed as “Smartlipo”) has been available for years with a proven … Continue reading

Chin liposuction improves neck contour dramatically and removes double chin. Dr. Sterry wants you to have the best chin liposuction possible with an elegant neck.

Is Kybella Better Than Chin Liposuction?

Kybella is the new FDA approved product for injection that melts the fat in your neck to remove the dreaded double chin. Studies performed by the company were very promising and we are seeing some nice improvements in our patients as well. The question that arises however, is whether or not Kybella will replace chin liposuction as the mainstay of treatment to create an elegant look in patients who are not ready for a neck lift.

Neck or Chin Liposuction For Neck Contouring

Neck liposuction (typically performed as “Smartlipo”) has been available for years with a proven track record of reliably beautiful outcomes. It is a brief procedure taking only about 40 minutes or so (including the laser portion to help melt fat and tighten skin) using only local anesthesia. As a minimally invasive procedure, there is a period of about 4 days when I ask my patients to wear a chin/neck compression garment to help insure a nice result. While I don’t use a scalpel, there is one stitch used in the chin which needs to be removed in 5 days or so. Results can sometimes be seen within days, but more typically 4-6 weeks later (see more examples at drsterry.com). Patients can expect a profound improvement in the jawline as well as reduction or removal of the double chin. Many patients also note that their neck skin seems tighter as a result of the to the laser portion of the procedure.

Kybella For Double Chin Removal

Treatment with the Kybella product requires no “surgery” and takes just a few minutes to inject in experienced hands. Kylbella injections can be repeated up to 6 times about 1 month apart until the patient gets the result they want. It is also performed with some local anesthetic, but is a much less involved process than is laser assisted liposuction. The improved contour is strictly limited to the double chin region. Unlike liposuction effects, Kybella can only be used in the region just behind the chin crease down to the “Adam’s Apple”, and between the jowls, but NOT including them. I’ll explain why below.

Kybella injections can improve the double chin appearance without “surgery”. Note: Company Photo

Chin Liposuction vs. Kybella: Which One Is A Better Option?

The answer really depends on the patient, their anatomy, and what they want to achieve. First, Kybella is a quick and easy injection that is specifically designed to remove a double chin. However, the results can’t be extended past the double chin and will not treat an entire neck as liposuction can. That’s because Kybella is actually “Deoxycholic Acid” which literally dissolves everything it comes in contact with – whether fat, blood vessel, or nerve. With such a powerful solvent, it has been proven that treatment that wanders beyond the FDA approved treatment borders can end up hurting patients and causing quite a bit of trouble such as nerve damage if used outside of those areas. Don’t worry, it’s quite safe in the center of the double chin.

Double Chin Before And After Kybella Treatment. Note: Company Photo

Second, Liposuction requires the use of a compression garment to be worn around the head/neck region for 4 days to insure against the formation of a “seroma” (a collection of benign fluid). With Kybella there is essentially no postoperative care at all.

Third, cost. The cosmetic results of Kybella are largely dose dependent (doctor skill has little to do with the outcome). The financial expense for two doses of Kybella is roughly 85% of what double chin liposuction would cost in New York City. However, if you need more treatments, this will present a further cost to the patient for the product. There is potential to spend more for Kybella and get a less impressive result.

Do You Recommend Kybella Or Neck Liposuction?

In my office we try to examine each patient carefully to assess what kind of outcome they may get from each treatment. The way I see it, if I can get an equally good outcome from a less invasive procedure, that will only improve my reputation. So it’s in my best interest to advise patients of what I honestly believe is best for them. On the other hand, I do have the occasional patient who will absolutely NOT have “cosmetic surgery” and will only opt for the injection. There are an equal number of folks who will NOT allow me to inject what they see as “poison” into them and would rather have the fat removed with a small “Procedure”.

Kybella Can NOT Produce The Strong Jawline We Obtained For This Patient.

My job is simply to inform patients of the facts, as well as my own bias’ and let them know what I would do if they were a part of my family.

Plastic surgeon, Dr. Thomas P. Sterry, serving Manhattan and the surrounding area of New York City

]]>https://www.drsterry.com/blog/facial-surgery/kybella-vs-chin-liposuction-running-neck-and-neck/feed/06 Non-Surgical Cosmetic Procedures for Minimalistshttps://www.drsterry.com/blog/non-surgical/6-non-surgical-cosmetic-procedures-for-minimalists/
https://www.drsterry.com/blog/non-surgical/6-non-surgical-cosmetic-procedures-for-minimalists/#respondSat, 31 Oct 2015 17:24:55 +0000http://www.drsterry.com/blog/?p=608 Want an improved, more youthful appearance without undergoing a surgical procedure? Lucky for you, it’s no longer necessary to have invasive cosmetic surgery to improve your skin’s appearance. Experienced plastic surgeons can give you the results you desire with highly effective, minimally-invasive cosmetic procedures. Here is a list of the most common non-surgical cosmetic procedures that can give you a more radiant and youthful appearance with little to no downtime. 1. Laser Rejuvenation Laser rejuvenation and laser resurfacing are procedures that reduce wrinkles, acne scars and other blemishes to reveal younger looking skin. Laser rejuvenation directs short concentrated, pulsating … Continue reading

A laser rejuvenation procedure can take up to thirty minutes for partial layering or up to 2 hours for a full facial treatment. For mild treatment, recovery times are usually no more than one week, while more aggressive treatments can require up to three weeks.

2. Laser Hair Reduction

Laser hair reduction, which patients generally describe as less painful than waxing, involves aiming concentrated beams of light at hair follicles to destroy unwanted hair. While some regrowth may occur, it will be sparse compared to before, and the laser hair removal process is often repeated until the desired area stops growing hair altogether. An impressive 90 percent of patients have permanent hair loss after just 3-5 laser hair removal sessions. Each session will take up to an hour to perform. Recovery time is minimal, requiring only a couple of days for your skin to return to its normal state.

3. Facial Filler Injections

Facial volume loss is common problem that arises as skin ages. Hyaluronic acid injections are a popular choice for filling in lines, wrinkles and depressions in the face. The most common facial filler injections are:

● Juvederm This is a hyaluronic acid (a substance normally found in your skin) which does a great job of filling lines and wrinkles.

● Radiesse Unlike the other products here, Radiesse is made from tiny calcium-based microspheres that help to volumize the mid-face as well as fill the nasolabial folds

● Voluma is the latest facial filler. It is also a form of hyaluronic acid but has qualities that make it a better volumizer – much like Radiesse, but it should last about twice as long.

The results of these injections are immediately noticeable. It will take a week or less for swelling to go down.

4. Botox

Botox is the most popular injection to temporarily diminish wrinkles and facial lines. In fact, plasticsurgery.org reports that Botox is currently the top minimally-invasive cosmetic procedure, with 6.3 million patients receiving Botox treatments in 2013.

Botox is a diluted form of the botulinum toxin which safely relaxes muscles to create a more youthful appearance. Botox works to temporarily interrupt the transmission of nerve signals that reduce muscle contraction. Since it is derived from a potentially dangerous substance, only a trained physician should administer these injections. Much like hyaluronic acid gel fillers, swelling can take up to one week to go down.

5. Light Chemical Peels

Light Chemical Peels are a popular procedure for making skin look flawless and fresh. Chemical peels can use any number of mildly acidic substances to exfoliate the surface layer of skin. Removing superficial or dead skin makes room for the younger. smoother skin underneath to be seen. Most patients require more than one treatment session but can expect very nice and youthful results. Recovery takes anywhere from 4-7 days following procedure with only minor flaking.

People who undergo IPL photofacials notice immediate changes, including a more even skin tone and reduction in appearance of brown spots, large pores and signs of sun damage. Patients can often return to work immediately, although there may be some slight redness.

If you are interested in the New York metro area and are interested in minimally-invasive cosmetic procedures, contact our office at 214-249-4020 to schedule a consultation.

]]>https://www.drsterry.com/blog/non-surgical/6-non-surgical-cosmetic-procedures-for-minimalists/feed/0Jane and the Story of the Triplet New York Tummy Tuckhttps://www.drsterry.com/blog/body-contouring/jane-and-the-story-of-the-triplet-tummy-tuck/
https://www.drsterry.com/blog/body-contouring/jane-and-the-story-of-the-triplet-tummy-tuck/#respondFri, 16 Oct 2015 23:44:06 +0000http://www.drsterry.com/blog/?p=906Jane had triplets and originally approached to me to consider performing a Tummy Tuck (aka “abdominoplasty”) at the time of her cesarean section. I told her that I didn’t think it would be a good idea. I wanted her to have a nice result and I suggested that she have her children first and come back to speak to me a year later. In my opinion, it is a mistake to perform abdominoplasty at the time of C-section because none of the anatomic landmarks are in their proper place and the patient is bound end up with a suboptimal result (incidentally, I … Continue reading

Jane had triplets and originally approached to me to consider performing a Tummy Tuck (aka “abdominoplasty”) at the time of her cesarean section. I told her that I didn’t think it would be a good idea. I wanted her to have a nice result and I suggested that she have her children first and come back to speak to me a year later. In my opinion, it is a mistake to perform abdominoplasty at the time of C-section because none of the anatomic landmarks are in their proper place and the patient is bound end up with a suboptimal result (incidentally, I have blogged about how a tummy tuck can remove C-section scars in the past).

Three years after giving birth to her triplets she returned to my office looking like this:

This patient, “Jane”, had given birth to Triplets about three years before the photo was taken. She was upset by how “stretched” her belly had become.

She said that she was now prepared to do something about the appearance of her belly. She had been living this way long enough and now that her children were out of diapers and able to do various tasks on their own she felt that her life could fit an abdominoplasty into it. Frankly, I think that she did pretty well considering that she had triplets. While she has some loose skin laxity abdominal wall, she is not nearly as “stretched out” as many of my other patients who only had one baby. Occasionally, we even see a patient with a complete abdominal muscle separation called a “Diastasis Recti“. Jane was back at her regular job taking the commuter train every day to New York City after dropping her children off at day care. She struggled to find 2 weeks that she could take off and still have help at home with the kids without burden in her husband too much. In some ways the tummy tuck recovery was more problematic than the tummy tuck operation.

A Husband that Supports his Wife’s Tummy Tuck is a Smart Husband

Speaking of husbands, Jane’s husband wasn’t sure she needed this operation at all. He loved his wife that he wanted her to have what she was looking for, but he really didn’t think that she needed to have an operation. I have seen this story play out many times before. Husbands rarely want their wives to have surgery, but later they are typically happy they did after the fact.

How is a Triplet Tummy Tuck Done?

The same way as any other abdominoplasty, but with a little more effort…And so we went to the operating room. I did a little bit of liposuction in the flank area and removed all of the loose and stretched out lower abdominal skin. I also spent a fair amount of time building an “internal corset” by sewing the right and left abdominal muscles to one another in a shoe lace pattern from the chest all the way down to the pubic bone. This brought the widened and attenuated abdominal muscles closer to one another and serves to flatten out her tummy as well. Her wounds were closed in multiple layers using dissolvable sutures and a drain was left in place. To learn more about how this all works, I made a popular video about tummy tuck surgery a few years ago and I would suggest you check it out.

Nine days later I removed the drain and she was quite swollen. I have video entitled tummy tuck recovery that I highly suggest you have a look at if you are interested in this procedure.

Six weeks after her tummy tuck, Jane’s swelling is decreasing steadily, but this is not the “final” result of her tummy tuck.

Fortunately, Jane had a good sense to perform this operation in the fall which meant that she could cover her swelling and support garments with sweaters and did not need to expose her tummy anyone during her recovery. She had the entire winter to allow for her swelling to subside and for the scar to mature. Over the ensuing few weeks I saw her on a regular basis as her swelling is decreased steadily. By 3 months time she looks like this:

Jane’s 3 month results after her tummy tuck and liposuction of the flanks

The following May she was able to go out to the beach in a bikini! She had a great summer with her kids down at the beach sporting her new body without anybody knowing she had a secret tummy tuck!

]]>https://www.drsterry.com/blog/body-contouring/jane-and-the-story-of-the-triplet-tummy-tuck/feed/0How To Fix Diastasis Recti – Tighten Your Tummy After Pregnancyhttps://www.drsterry.com/blog/body-contouring/how-to-fix-diastasis-recti-tighten-your-tummy-after-pregnancy/
https://www.drsterry.com/blog/body-contouring/how-to-fix-diastasis-recti-tighten-your-tummy-after-pregnancy/#commentsFri, 02 Oct 2015 11:18:27 +0000http://www.drsterry.com/blog/?p=859As both a Plastic Surgeon AND (in a previous life) a Personal Trainer with a Master’s Degree in Exercise Physiology, I have learned quite a bit about the muscles that make up the abdominal wall. Many patients come to me and are upset that they can’t get their tummy flat again after child birth. Some of their friends look great after they had kids and they don’t understand why they can’t get their physique back to the shape they are used to from their youth. Some of them develop feelings of guilt or incompetence which are completely unfair. In this essay I’d … Continue reading

Patients with True Diastasis Recti tend to have a similar presentation

As both a Plastic Surgeon AND (in a previous life) a Personal Trainer with a Master’s Degree in Exercise Physiology, I have learned quite a bit about the muscles that make up the abdominal wall. Many patients come to me and are upset that they can’t get their tummy flat again after child birth. Some of their friends look great after they had kids and they don’t understand why they can’t get their physique back to the shape they are used to from their youth. Some of them develop feelings of guilt or incompetence which are completely unfair. In this essay I’d like to explain what the problem really is and why exercise and diet will NOT help you overcome a true diastasis recti completely. Let me emphasize, however, that diastasis recti is an unusual circumstance and the MOST women simply develop laxity of their abdominal wall after pregnancy. While this too can be frustrating and sometimes difficult to overcome without surgery, it is NOT the same entity as a diastasis recti.

As depicted above, women with a real separation of the muscle of the abdominal wall have a very specific appearance and look very much like each other. There is almost always a profound protuberance near the umbilicus and hanging skin below that. With poor diet and lack of exercise or with many post pregnancy tummies, the excess skin and the belly paunch are both lower and might even hang down, but they tend to be together. Not so with a diastasis recti. So, what exactly is going on here?

What is Diastasis Recti?

Diastasis Recti presents as a large “Bulge” in the abdomen when the abdominal muscles are flexed, but it is NOT a hernia.

A “diastasis recti” is a loosening of the connective tissue in the center of the abdomen called the “Linea Alba”. This is a fascial band (thick tissue) that connects the right and left Rectus Abdominus muscles (they make up the “six pack”) to each other and is responsible for the visible groove that many slim people have running from the umbilicus up to the chest.

During pregnancy there are substances called Prostaglandins that circulate through the body and allow everything to dilate, stretch, and get loose to accommodate the growing baby. This includes the uterus, blood vessels, and yes – the abdominal wall (including the line alba). During the first year post pregnancy, many of these structures snap back to tone in most people and the woman gets her old shape back, but not for everybody. Some women end up with loose tummy skin, sagging breasts, larger nipples than they had before pregnancy, or a widened space between their rectus abdominus muscles – and this is what we call the “Diastasis Recti”.

Below I have inserted a short (and graphic) video from the operating room, in which I address diastastis recti on a tummy tuck patient. It depicts the loose connective tissue between the rectus abdominus muscles. Viewer discretion is advised.

So, for women with diastasis recti the abdominal muscles remain separated widely by several inches creating the appearance that they have a pot belly. In some instances it looks more like a large hernia. And in some rare cases I have seen the small intestine wiggling around under the skin (a process called “peristalsis”) as if there were a snake below wandering through the tummy. With the right kind of muscle flexion the belly may even stick out as if there were a hernia present.

Why Won’t Insurance Pay To Fix My Diastasis Recti?

Diastasis recti is a quirky little problem to have because although the cases can be rather severe and disfiguring, insurance companies don’t want to pay to fix them because there is no “functional problem” caused by the issue. Their argument is that the fascia (connective tissue) might be weak, but remains intact across the abdominal wall, so there is nothing that is “medically necessary” to fix. CT scans will confirm that the patient has intact anatomy without a hernia or break in the abdominal wall structure. However, in terms of basic normal form, this situation clearly goes off the rails.

Actual patient of Dr. Sterry who required repair of diastasis recti shown before and 3 months after procedure

For patients with this issue, life can become very depressing. The insurance company won’t help, the CT report says you are fine, and some friends and family gently intimate that you should really go to the gym and work out a little harder to get through this problem. They clearly don’t understand what’s going on.

Why Won’t Exercise Help Fix My Diastasis Recti?

As a previous personal trainer I’m a huge believer in physical fitness and an advocate for anyone who believes in self reliance. That said, I’m also a realist and an advocate for patients, and this problem needs surgery. There are no two ways about it. It is no different than having a bone broken completely in half so that it is not lined up properly anymore. Unless it is put back in place, it can’t possibly heal in a straight line the way it was before – it just doesn’t work that way. In the case of diastasis recti, the muscles need to be put back in their proper place in order to restore normal function. If that doesn’t happen, then no matter how strong you might make them with exercise, they will remain separated from each other and you will always have that bulge emerge between them.

A Normal Abdominal Wall Has a Short, Thick Connection Between The Rectus Abdominus Muscles called the “Linea Alba”

I have noticed recently that there are some charlatans (yes, I believe these are dishonest people) out their claiming that if you do their workout (for a fee) they will help you build up your “transversus abdominus” muscles to fix your diastasis recti. They claim to have published proof in medical journals that their techniques work. I encourage anyone to try whatever methods are available. You should ALWAYS try to avoid surgery if you can. However, if your diastasis doesn’t get better in the first 18 months after pregnancy, it’s not likely to to improve on its own. Perhaps it was never a real diastasis to begin with, but just some laxity that rebounds with the hormonal changes after pregnancy.

In Diastasis Recti, The Connection Between The Rectus Abdominus Muscles Is Widened and Thinned Out Dramatically

How do I know this? First, let’s start with basic ideas and then move into anatomy. When a muscle flexes, it gets shorter and pulls whatever is attached to it closer. The anterior abdominal wall (your belly) is made up of four muscles all running in different directions. Importantly, NONE of them cross the midline or flex from one side to the other. They all run their course on either the right or the left sides of the belly. There is no connection between the right and left except for the fascia in the midline – which is what gets loose in a diastasis recti scenario. Therefore, strengthening these muscles cannot pull the two sides of the abdomen together. In fact, it might only serve to pull them farther apart.

The second way I can prove this is by experience in the Operating Room. Have a look below at the very thin and attenuated connective tissue between the two major abdominal muscles in this patient. There is no exercise in the world that would strengthen this layer because there is no muscle in it. Have a look below:

In Diastasis Recti the connective tissue is loose and floppy. Note: There is NO MUSCLE to exercise and strengthen across the midline.

How To Fix Diastasis Recti

The preferred way to fix a diastasis recti is via a tummy tuck incision because it results in a hidden scar, which can be performed in a standalone abdominoplasty procedure or as part of a mommy makeover. Certainly, the problem can be addressed with a midline incision running up and down the middle of the belly, but most of us would not want that. In an effort to be more “stealthy” an incision can instead be made across the lower tummy in the bikini line. The skin of the abdomen is then undermined to expose the separated muscles. Sutures are then placed running from one side across to the other like a shoe lace in order to create a sort of internal corset. By repositioning the muscles back in the middle of the tummy we effectively restore normal anatomy and eliminate the bulge that is so bothersome.

CLICK HERE: Repair of Diastasis Recti is typically performed at the time of a Tummy Tuck

What About Women With Laxity Of The Abdominal Wall, But NOT Diastasis Recti?

More common than diastasis recti is a laxity of the abdominal wall after having been stretched to accommodate either pregnancies or after major weight loss. In these cases the abdominal muscles are all intact, but the connective tissues have developed laxity leaving the tummy to protrude more than it did before their pregnancies. This situation is also many times a surgical problem, even for slender people, but it typically doesn’t have the dramatic presentation that a diastasis recti does. Certainly many of these folks will end up getting tummy tucks as well and they probably look much better than they would without the surgery, but the anatomical problem is not at all the same.

]]>https://www.drsterry.com/blog/body-contouring/how-to-fix-diastasis-recti-tighten-your-tummy-after-pregnancy/feed/51Scar Removal: Advice From A New York City Plastic Surgeonhttps://www.drsterry.com/blog/scar-revision/scar-removal-advice-from-a-new-york-city-plastic-surgeon/
https://www.drsterry.com/blog/scar-revision/scar-removal-advice-from-a-new-york-city-plastic-surgeon/#commentsThu, 26 Mar 2015 00:24:04 +0000http://www.drsterry.com/blog/?p=801Scar Revision As a plastic surgeon working in New York City I see all manner of injuries and surgical scars in every type and color of skin on this earth. Most times scars heal well or at least don’t bother patients. Occasionally however, the mark left behind is either in a particularly bad place (like the face) or heals with an unacceptably bad scar. These scars may not only be ugly to the observer, but can sometimes affect the functionality of the patient by causing constriction in movement (especially across joints). This is where the art of plastic surgery might … Continue reading

Scar Revision

As a plastic surgeon working in New York City I see all manner of injuries and surgical scars in every type and color of skin on this earth. Most times scars heal well or at least don’t bother patients. Occasionally however, the mark left behind is either in a particularly bad place (like the face) or heals with an unacceptably bad scar. These scars may not only be ugly to the observer, but can sometimes affect the functionality of the patient by causing constriction in movement (especially across joints). This is where the art of plastic surgery might be appreciated by even the most staunch opponents of plastic surgery.

Scar Revision and Belly Button Creation for a young woman with a bad abdominal scar.

Why Do Scars Heal Poorly?

This is one of the key questions of surgery and we may never get a 100% complete answer. Wound healing is clearly genetic to a large extent with some people being more prone to making thick scars than others. For instance, African American patients who come to my office are very cautious about their chances of producing a keloid scar (a scar that extends beyond the borders of the original injury). Interestingly, my experience has been that the Asian population is at greater risk of keloids than anyone else. That doesn’t mean that everyone in these populations makes poor scars, but when I do RARELY see a keloid, it is many times in one of these ethnic groups.

Beyond genetics or God’s will, there are environmental influencers of scar formation. For instance, if a wound was infected it may very well form a bad scar. Infections will many times lead to thickened scar tissue, wounds that open up and have to heal from the inside out, or scars that are tethered (stuck) down to the underlying tissues of the body creating divots or dents. If a wound is closed under tension, the body seems to react to the need for more aggressive healing by depositing more collagen in the area leading to a thicker scar. There are also parts of the body that are known to be more likely to create bad scars. The center of the chest, the earlobes, and in my experience the upper arm all fall into that category. All of these factors create a more obvious and less appealing scar long term.

Poorly Healed Arm Scar was Removed and Closed Again

Keloid Vs. Hypertrophic Scars

A “keloid” scar is a scar that grows out beyond the borders of the original wound. They are a terrible problem and can be very tricky to get rid of because once you have one, there is always a risk that any attempt to remove it could result in another keloid that is worse than the first one. There are a handful of treatments for keloids including the injection of steroids, anti cancer drugs, and even radiation therapy. The best results seem to require excision of the keloid with the immediate use of one of these adjuvant therapies. The theory is that by limiting the earliest wound healing processes (what doctors call an influx of “macrophages”) we can prevent an overabundance of collagen deposition in the area.

A “hypertrophic scar” in contrast to a keloid is simply a scar that is a little thick, or that we don’t particularly like. I have many patients who tell me about how they “keloid” when in fact they simply have a hypertrophic scar. Luckily, the treatment of a hypertrophic scar is a whole lot simpler than that for a keloid. Many times I will simply give the patient an injection of steroid and the scar settles down pretty quickly. Other times we go to any of the other treatments that I’ve described in this writing with good outcomes.

Vitamin E is Bad For Your Scar, Silicone Gel Is Good

Plastic Surgeons and Dermatologists have known for years that Vitamin E is bad for the cosmetic healing of scars. Vitamin E is proven to decrease the tensile strength of wounds and produce less favorable scarring than doing nothing at all. I’ve been telling patients this for years, but most don’t really believe me because their mothers, friends, and sometimes television tells them otherwise. It’s an uphill battle, but I keep trying.

In my practice, I suggest the use of silicone gel as an effective method to improve the appearance of scars. This is supported with real clinical research both on the laboratory bench and in clinical studies. Actually, silicone sheets are also very effective, but I find patients are more likely to stick with the gel because it is much easier to use. Patients tend to complain about the sheets and they become very expensive over time as repeated use seems to make them somewhat “dirty” and patients don’t want to use them after a while. The gel is simple, dries fast, and patients are more likely to stick with the regimen for the 6-8 months required to really make a difference.

Basic Scar Revision

The hypertrophic scar was removed, hernia was repaired, and a brand new scar was created which is much more cosmetically acceptable. Even the belly button was put back in place.

Sometimes the most obvious thing to do with a bad scar is simply to remove the bad scar tissue and close the wound all over again in a very similar manner. This can work out well, depending on the situation. That is, one has to ask oneself why the scar is likely to form more favorably on the second go round than the first. For instance, were the wound edges lined up properly the first time? Was there some kind of contamination or infection that caused poor wound healing? In those cases, a simple scar revision can certainly result in a more acceptable cosmetic appearance of the scar.

Sometimes there can be too much tension on the closure of a wound the first time around which caused the body to react profoundly and deposit a lot of collagen in the area causing a thickened scar to form? If the surgeon can somehow relieve that tension (perhaps by creating a “flap”), then the outcome might be better the second time around as well. This situation comes up all the time in cases like bad tummy tuck scars or after general surgery.

Z-Plasty Can Help Release Constricting Scars

Z-Plasty across the wrist and at the proximal part of the forearm combined with removal of the old scar helped ensure this woman regained full function of her hand without restriction.

If a scar crosses a joint like an elbow, knee, or even your neck there is a procedure called a “Z-Plasty” that can help to release the constriction by recruiting some non scarred surrounding tissue into the central portion of the troublesome area. There are times when this makes the scar more cosmetically acceptable, but generally speaking this technique is used to restore function to the patient. It is a commonly utilized strategy in hand surgery (because there are so many scars that cross joints in that field) as well as burn surgery (because these wounds tend to be large and cause great constriction. However, Z-Plasty is used in any situation where we need a little tissue rearrangement.

W-Plasty To Help Camouflage Scars

A “W-Plasty” is similar to a Z-Plasty in that we create a zig-zag scar, but in the W-Plasty the zig-zag is continuous along the length of the scar. It is particularly useful in scars that run in the opposite direction as the natural lines in the body or face because we can take (for instance) a vertical scar and create a series of smaller 45 degree angles that are closer to the horizontal lines we normally find in nature. This seems to throw off the eye of the onlooker so that the scars is not quite so noticeable. That is, the wound runs opposite to the normal creases we would see naturally, but the series of smaller scar lines are now 50% closer to them. It is a very handy procedure in the right circumstances, but patients in general are reticent to the idea because they are afraid the wound might look more like the mark of Zorro than a better scar.

This scar was even more obvious when the patient spoke because it would tether the lip down and accentuate the injury. The W-Plasty broke up the restriction and made the scar less noticeable. Dermabrasion was also used to help the scar to blend into the surrounding tissues.

Dermabrasion To Help Scars Blend In

Once a scar has been optimized by any of the other methods described here, we still have a few techniques that can help scars to “blend” into the surrounding skin. One of these is called “dermabrasion“. This is a technique that essentially uses a small grinding wheel as a handheld device to physically file down a scar and the normal tissues immediately surrounding it. By removing the top layer of skin in these areas we cause the entire area to heal or “re-epithelialize” in unison and that can help the scar to be less noticeable. It is very effective and handy. Plastic surgeons like this technique for getting rid of wrinkles around the mouth that a facelift can’t quite achieve. Sometimes dermatologists will try to cover large areas of skin like the cheeks after acne scarring and they call this “derma planing”. Amongst the limitations with this procedure is that it is very user dependent and difficult to get large areas of skin to be completely uniform.

Complete Removal Of A Scar

To say that we can “remove a scar” is sort of a misrepresentation of our abilities. Once a scar has been formed, it may fade with time, but it will never completely “go away”. On the other hand, we do have the ability to remove one scar and “trade” it for a different one… and this trick is worth doing from time to time. For instance, perhaps there is a vertical scar on the lower tummy of a woman after having a Cesarean Section (“C-section”). We certainly have the ability to remove all of the lower tummy skin and convert the “up and down” scar, which is visible to the whole world, to a gentle horizontal “smile” scar across the lower bikini line with the use of a classic tummy tuck procedure. The only visible scar to the public would be around the umbilicus and I’ve written quite a bit about that issue in my other posts. Other examples might include any number of breast procedures or thigh lift operations – all of which involve removing skin which, if scarred, would eliminate an unfavorable scar for a more cosmetically acceptable or hidden scar.

Laser Treatments That Lessen Scars

There are several types of lasers that can be helpful in our battle against scars. These can be categorized as Ablative, Vascular, and Fractional Non-Ablative lasers.

Ablative lasers can be used in much the same way as dermabrasion. They essentially sear the surface of the skin and take away the surface level of skin in the hopes that when the scarred area and surrounding tissues heal they appear more uniform. The advantage over derma planing is that these devices are less user dependent and results seem to be more reliable when treating large surface areas – as with acne scarring.

Vascular lasers help to remove redness from scars. They use a specific wavelength that is absorbed by the red color and essentially burns it out of the area. The result can be a scar that is less red, and hopefully has a pigment more like the surrounding skin.

Fractional Non-Ablative lasers are not supposed to take away the skin surface, but rather they deliver heat down into the scar in micro “tunnels”. The theory is that they can burr thousands of microscopic holes of heat into the scar and encourage the skin to heal again in a more uniform manner. While the idea is inviting, I have not been impressed with this technology in my practice and have completely abandoned the technology for now.

Injections To Improve The Appearance Of Scars

There are some occasions when injectable materials like Juvederm can help scars to look better. For instance, let’s say that there is a depressed scar that looks like a dent in the skin. It may not make sense to operate because the scar is so small and we want to do as little as possible to get a favorable outcome. So in these cases we can sometimes inject a little filler under the scar to make it “pop” up to the same level as the surrounding surface skin. When it works, it’s a home run, however fillers are a little pricey and the results may only last a year or so (based on the longevity of the filler). For these reasons I typically will check to see if I can get the scar to pop by injecting saline first. If the scar is not tethered down to the underlying tissues it will smooth out, and then I know that a filler can help. On the other hand, if the scar won’t budge because of the connections below, then I know that I need to try some kind of lysis (sub dermal release of the scar). This can sometimes be achieved with a needle or a device such as a “diamond wire” that is specifically designed for “subcision” of the scar.

Will Insurance Pay For Scar Revision?

Your health insurance company is supposed to be there to help pay for “health” or medically necessary procedures. As such, insurers are not exactly going to leap at the opportunity to help you get a cosmetic scar revision. However, if a scar is actually preventing you from leading a healthy and productive life, then they may. For instance, if there is a scar restricting movement of your hands or arms so that you can’t work, then a scar revision would be deemed “medically necessary” and your insurance carrier would likely pay for that kind of revision. On the other hand, if a patient doesn’t like the appearance of your acne scarring, that is probably going to be considered an elective cosmetic procedure and the expense would be on the individual. The tricky part here is that some insurance companies will deny any and all scar revisions because some patients will make claims about their inability to work due to a cosmetic scar – so there is definitely a struggle in many cases to determine what is fair. As a plastic surgeon, I do my best to walk the line between these opposing views. I want what is best for my patients and I advocate for them every day, but sometimes we need to concede that a given procedure is simply cosmetic in nature.

]]>https://www.drsterry.com/blog/scar-revision/scar-removal-advice-from-a-new-york-city-plastic-surgeon/feed/26The Selfie Chin Solution: How Neck Liposuction Can Improve Your Profilehttps://www.drsterry.com/blog/facial-surgery/the-selfie-chin-solution-how-neck-liposuction-can-improve-your-profile/
https://www.drsterry.com/blog/facial-surgery/the-selfie-chin-solution-how-neck-liposuction-can-improve-your-profile/#commentsSat, 14 Feb 2015 15:02:33 +0000http://www.drsterry.com/blog/?p=761 Liposuction is highly effective at contouring the chin and jowls. I have spoken quite a bit for the last few years about how Smartlipo liposuction of the chin and neck can improve your profile. Actually, while I’m inclined to call this neck liposuction, I find many of my patients refer to the chin liposuction. I think that’s because many of them have a “selfie chin” – and they all seem to hate it! In the end, it really doesn’t matter what we call it. The point is that nowadays we are able to improve the profile of many patients … Continue reading

Liposuction is highly effective at contouring the chin and jowls.

I have spoken quite a bit for the last few years about how Smartlipo liposuction of the chin and neck can improve your profile. Actually, while I’m inclined to call this neck liposuction, I find many of my patients refer to the chin liposuction. I think that’s because many of them have a “selfie chin” – and they all seem to hate it! In the end, it really doesn’t matter what we call it. The point is that nowadays we are able to improve the profile of many patients using a relatively simple technique that can both contour the jawline and tighten the skin at the same time. Until recently, “experts” might have told patients that in order to remove jowls a facelift was necessary – and sometimes it still is, but NOT all of the time. A facelift takes hours to perform nicely and involves significant down time, whereas a liposuction procedure on the chin or neck only takes about 45 minutes to perform (under local anesthetic in the comfort of my office) and the recovery time is just a few days.

Selfie chin can be removed simply.

Double Chin or “Selfie Chin” – Removed with Smartlipo Liposuction of the Neck

I find a lot of patients coming in these days as a result of facetime and skype videos that showcase their double chin. I also know a professional photographer who tells me that the first thing she photoshops for her clients is their neck and jawline because the subjects look so much better when she does. She then pointed out that these people pay thousands for her pictures and even more for her photoshop abilities to make them look better. In fact, for the same money they can potentially just have the real double chin removed and then not have to pay her for the computer morphing time.

Simple procedure performed under local anesthetic.

The nicest part about Smartlipo on the neck or chin is that it can be done under local anesthesia. We begin by making a few pinholes in the skin so that we can infiltrate the area with local anesthetic. That’s right, no scalpel necessary! I like to make the needle holes in the chin and behind each ear. Don’t worry, there will be no perceptible scar when we are done. When the local is injected it might burn a little, but this only lasts for about 90 seconds to two minutes. Once this step is complete, patients don’t feel any discomfort.

Next, we treat the tissues with the Smartlipo laser. This is actually a big box that has a laser in it but allows a sterile fiber-optic cable to be connected. The cable is 1 mm thick and slides into a cannula that is used to treat the area.

The cannula is then inserted into the pin holes we made earlier and when we fire the laser, it melts the fat.

Skin tightening is remarkable

The best part about this procedure is the contraction of the tissues around the chin and neck. This is a topic that has received a lot of attention in the surgical literature because many of us are skeptical, but some studies are convincing. There seems to be no need for removal of excess skin in well chosen cases. Even in the example below, I truly thought I was going to need to perform a neck lift operation in order to get the patient a nice result, but it never happened. I will admit that she still has a little loose skin directly behind the chin, but this is nothing compared to where she started out. She was the original patient who made me believe that the laser energy from the Smartlipo really does help the skin to tighten a bit.

I expected this patient to need a neck lift, but the Smartlipo Laser seems to have caused enough skin contraction to avoid that

Now, we should pause for here to explain something about this technology. Plastic surgeons all agree that the laser helps to melt fat, but we disagree on whether or not it actually helps to tighten skin. I am clearly a believer. In my experience, skin on the neck and arms truly seems to get more snug and my results are better than they were a few years ago (before I had a Smartlipo machine). That said, I am not so convinced that it tightens skin on the abdomen or flanks – good thing this post is about the neck and chin!

Profile can Improve Nicely

There is a very nice improvement in patients profiles, but there does seem to be a difference between the genders. In men, the results tend to be a little more subtle and can take a few weeks to develop. In some ways that is good because they are much more secretive about such activities than women – so small changes are sometimes better for them.

Profile Improvement with Dr. Sterry’s Selfie Chin Solution

In women, recovery seems to take two forms. They either get results immediately, or it takes 3-6 weeks for the outcome to be apparent. Importantly, however, friends and family can’t typically quite figure out what it is that they’ve done. They just look good!

Patients look thinner despite removal of very little fat

Neck Liposuction Mimics Weight Loss

It’s a funny thing how such a relatively small amount of tissue removal can appear as such a significant change in the appearance of a patient. I typically take out only about 200 cc’s of fat and fluid (the tumescent fluid that is injected), yet the change in the appearance of the patients is remarkable and patients appear to be impressively more slender. In fact, patients tell me that the most common question they get from friends and family is whether or not they’ve lost weight. I repeat, it’s only 200 cc’s of liposuction, but the area that it is taken from makes a huge difference. Again, I love the fact that patients look better, but nobody can quite tell why.

Additional small procedures augment the results

A little bit of Mid-Cheek injectable filler helped this patient regain her appearance from years ago.

Rather than having one big procedure that can dramatically change a patients look (e.g. a full facelift), sometimes the subtleties of multiple small changes can have a more stealthy, but still impressive outcome. For instance, many times a patient who wants neck or chin liposuction will also be a good candidate for some facial fillers. Again, “subtle” is the operative word in my office. I am not a fan of pumping gallons of filler or botox into patients’ faces and making them look strange. I just like to replenish some of their lost volume, or play down some of the lines that may have developed over the years.

Patients appear younger

This is a matter of opinion, but in my mind the majority of neck liposuction patients look younger. I know this is subject to interpretation, but looking at the examples I’ve presented here, I think most onlookers would agree with me.

Results in Smartlipo of the Neck for Men can take longer to mature, but are still significant

There is some science to theories of beauty, and I don’t think I’m completely off base here. As people get older they tend to develop a heavier neck and jowls. So even if a young person has them, they look a little older because of it. When we take that heavy appearance away, the onlooker doesn’t interpret their appearance to be as old anymore.

How Long Will the Results of Chin Liposuction last?

We have no reason to think that these results are not permanent. I have stated in other posts that once the fat cells are removed from an area, it is very difficult to re-gain fat in that region. That said, the proof is in the pudding. I have had several patients return to my office for other reason years after having Smartlipo of the neck and they all seem to maintain very nice results. An example is the woman below who came in 3 years after her neck lipo and still looks great.

Patient Shown Before, at 3 months post, and 3 years after Smartlipo of the Neck and Chin.

]]>https://www.drsterry.com/blog/facial-surgery/the-selfie-chin-solution-how-neck-liposuction-can-improve-your-profile/feed/14Liposuction Today = Bikini In May!https://www.drsterry.com/blog/body-contouring/liposuction-today-bikini-in-may/
https://www.drsterry.com/blog/body-contouring/liposuction-today-bikini-in-may/#respondThu, 05 Feb 2015 20:16:23 +0000http://www.drsterry.com/blog/?p=698If you want to turn heads next spring, then winter is the perfect time for liposuction. Why? Liposuction can get rid of stubborn areas of fat that’s resistant to diet and exercise—but the results aren’t visible overnight. By its nature, liposuction results in a fair amount of swelling. Patients are often about the same size the day after a procedure as they were before the liposuction was performed, but they are a little sore and bruised. I find patients aren’t truly appreciating their results until about six weeks later, and the final result is a good 3-4 months away. So, … Continue reading

]]>If you want to turn heads next spring, then winter is the perfect time for liposuction.

Liposuction in the Cooler Months will get you bikini ready by May

Why? Liposuction can get rid of stubborn areas of fat that’s resistant to diet and exercise—but the results aren’t visible overnight. By its nature, liposuction results in a fair amount of swelling. Patients are often about the same size the day after a procedure as they were before the liposuction was performed, but they are a little sore and bruised. I find patients aren’t truly appreciating their results until about six weeks later, and the final result is a good 3-4 months away. So, while we talk about liposuction having a “weekend of down time” we are referring to the acute recovery phase, but you need to allow time for that swelling to subside so that you can enjoy your results.

Want to look trimmer this spring? Start now!

During the first week of January, I got a request for liposuction from a woman who wants to look good for spring break (she was the impetus for my writing this post). What many people don’t understand is that it takes at least 6 weeks after liposuction to see 80% of the results. Liposuction patients still don’t look their absolute best until 3 to 4 months after surgery—and technically, it takes a year for all of the swelling to subside.

Female Flanks before and 3 months after liposuction at STERRYMD

So if you have a special occasion you want to be ready for—a June wedding, a reunion or cruise—plan ahead to allow plenty of time for healing so you can enjoy the results of your liposuction.

How Can Swelling From Liposuction Be Reduced?

The first step in liposuction is to inject a numbing solution called “Tumescent Fluid”, but when the procedure is done, this solution can irritate the tissues in the area that was treated. I find that by allowing the tumescent fluid to drain for the first day after the procedure, there is a lot less swelling and bruising for my patients. This is called the “Open Drainage Technique” and has become one of the most powerful ways we have to decrease the discomfort and swelling of liposuction in the immediate postop period. I still use sutures to close the small 3 millimeter incisions, but I no longer attempt to seal them with a water tight dressing. This technique has made a tremendous difference to my patients and I notice them recovering much faster with less swelling than I saw a few years ago. It is a little bit messy for patients during that first 24 hours after the procedure and they need to change some dressings during that day, but it is clearly worth the trade off for the sake of increased comfort and dramatically less bruising.

Liposuction Swelling Progression Using The Open Drainage Technique

Of course, wearing a compression garment in the weeks following liposuction is also a key factor in keeping swelling at bay. It also helps to increase comfort because when tissues swell, they become more painful. Lastly, the compression garment also helps to prevent problems such as a “seroma” (a collection of fluid under the skin) which can frustrate and prolong your recovery.

There are a few herbal supplements available that also claim to reduce swelling. The most popular is a pineapple extract called “Bromelain” and has been clinically proven to help decrease swelling in actual after surgery.

What Are The Most Common Liposuction Areas?

Most people want their tummy suctioned. After all, it is our bellies that we see when we look in the mirror and Lord knows it can be very depressing to see! However, what most patients don’t realize is that while we only see our front in the mirror, the rest of the world sees the other 75% of our torso from the back and sides. When patients really want to look slender I like to suction the flanks as well as the abdomen. In this way, I am essentially treating the entire torso 360 degrees around. In my experience, these patients are a lot more satisfied with their results than the folks who only suction their tummy. In fact, I will sometimes encourage patients to suction their back/flank region instead of their abdomen if they are only able to do one single area. I think suctioning the flanks does a better job of creating a nice waistline than does suctioning the tummy alone.

Abdomen and Flank Liposuction Combination is Very Common

Requests for liposuction are also many times gender based. Women classically want to remove their saddle sacks, or inner thighs. Men want to remove their “spare tire”. However, in general there are a few basic combinations that we find ourselves suctioning on a regular basis – like the abdomen and flanks combination.

Smartlipo is the original laser-assisted liposuction. It has been promoted as simple and less invasive than classic liposuction. Its maker (Cynosure) says you don’t need general anesthesia for Smartlipo, which is true. But you never did need general anesthesia for lipo; I do 98% of my liposuction procedures under local anesthesia.

I tell patients that Smartlipo is actually more invasive because it is an added step. After we tumesce the tissues a CO2 (carbon dioxide) laser cannula is passed under the skin, which melts the fat, and coagulates blood vessels. That is why there is less bruising than with traditional liposuction. Furthermore, now that the fat has been melted, I am able to use a smaller cannula (the tube for removing fat through liposuction). So, in my mind, Smartlipo makes regular liposuction more efficient and complete.

Smartlipo helps for Contouring, BUT I’m NOT convinced that it tightens skin on the torso or thighs

Does Smartlipo Tighten Skin?

The big question about Smartlipo is whether or not it actually helps to tighten the skin as the company claims it does. That’s been hard to prove despite several studies that claim to demonstrate true “skin tightening”. The truth is that this is a difficult thing to demonstrate and many plastic surgeons are not convinced. Plus, the key research papers on the topic supporting the claim have all been sponsored by Cynosure, who makes the product. So many of us in the field are suspicious of the data presented.

I am convinced that Smartlipo of the Neck helps with Skin Tightening

In my experience, I do believe that I can see the skin is tighter when using Smartlipo on the neck and arms. In fact, it can be pretty dramatic, so I know the device is doing something to the dermis (skin). Unfortunately, it’s not so obvious on the belly or outer thighs – where so many people want these procedures done. Other practitioners may disagree, but that has been my experience and I think when you look at my photo gallery, most people would see why I say so.

Smartlipo Streamlines the Neck

Smartlipo on the neck has been the most popular procedure in my office for the last two years. It gives a consistently nice result streamlining the neck, contouring the chin, and even removing jowls. Interestingly, I’ve found that results take longer to develop in men as compared to women, and their results are more subtle. But in some ways that is better for the men, who are so much more discreet about their plastic surgery procedures than women are. (BTW, I find that men will NEVER admit that they have had a procedure done, while many (not all) women will lunch with their friends and talk freely about what they did and how things came out.)

Now, getting back to recovery, in my experience, results for women who have Smartlipo on the neck fall into 2 groups:

One group gets better immediately, as this patient who had Smartlipo on a Monday and was thrilled to see results by that Friday.

The other group lingers 6 to 8 weeks before the results of their neck Smartlipo take shape, but they still get very nice results.Unfortunately, I have not yet figured out how to predict which group a given patient will be in before we do the procedure. I wish I had a crystal ball so that I could tell the patients exactly what to expect ahead of time, but so far, no luck on that one.

I think it is also fair to note that some women will complain about lumpiness on their neck that they can feel, but not typically see. I’m not sure if this represents swollen glands and lymph nodes or perhaps some fat that gets hard for a while, but in either case it seems to present itself at about 3 weeks and disappears by 8-12 weeks if it happens at all. Once in a while I also see some streaky skin bands running vertically up and down the neck in female patients.

Arm lift or Smartlipo?

A lot of people who want an arm lift do well with Smartlipo. Unlike an arm lift, there’s no visible incision with Smartlipo. Whether Smartlipo would work well for you depends on whether you have a lot of excess skin on your upper arms. I’ve seen patients who were overweight but had good skin tone have very good outcomes with Smartlipo. It all depends on the skin tone.

Smartlipo seems to tighten the tissues of the arms

Do You Have Areas of Fat that Just Won’t Budge?

You’re not alone. I’ve had personal trainers who couldn’t get rid of excess fat on their flanks, and a nutritionist with 6-pack abs who still had saddlebags. When diet and exercise are not enough, liposuction can be the answer. Take a look at the example below:

This patient claimed to be in the best shape of his life, but nobody knew it. Once we removed the “insulation” all the hard work on his muscles started to show through.

This patient told me that he was in “the best shape of my life, but nobody knows it!”. He told me that he could lift more and run a 5K faster than he ever had before. He was living in the gym 90 minutes at a time 4 days each week, but he didn’t have the rewards he was hoping for. A little “liposculpture” (aka: high definition liposuction), helped to remove the fatty tissue that was masking all of his hard work. He now feels like all of his hard work was finally paying off.

What about Vaser liposuction?

Vaser liposuction has been around a long time. It is very similar to Smartlipo except that it’s based on ultrasound energy rather than a laser.. Is it better than Smartlipo? The question is, in whose hands? Both technologies do essentially the same thing—they are using some kind of energy to melt fat. Some of its proponents claim that it is more powerful and more useful than other modalities because it can melt a wider area of fat than Smartlipo. I argue that this is a double edged sword because if we damage too much fat in an un-artistic way, then we risk problems like divits, dents, and grooves that are visible after the procedure is done.

Both Vaser and Smartlipo have claims of skin tightening. Smartlipo Triplex has 3 different wavelengths: 1064 nm (which is the original), 1320, and 1440—which is much more powerful than the other wavelengths. That is to say, the 1440 wavelength has 40 times the fat melting capacity of the others and brings Smartlipo closet to the effectiveness at treating large areas as the Vaser ultrasound technology. Again, always remembering that maybe more fat melting isn’t necessarily better.

Are there any non-invasive fat-reduction techniques?

It would be great if we could remove fat without needing any invasive procedure at all. And while everyone wants less invasive procedures, some people will do anything to avoid having “surgery”. I understand that, but right now I see a lot of patients who have tried going the strict Non-Invasive route and come to me later because they are unsatisfied with their results. It is generally accepted in the plastic surgery world that while these methods are desirable, they’re just not as effective as liposuction…yet. As of 2015, removing the fat from a given area with a suctioning technique remains the gold standard in body contouring. That said, this essay wouldn’t be complete if I didn’t mention a few of the strictly Non-Invasive fat removal techniques available and explained how they work:

Coolsculpting uses large suction cups attached to the body to basically freeze the unwanted fat. Each treated area takes about an hour to complete (that is two hours for the right and left sides). During the ensuing weeks, the fat cells in the area die and your body absorbs those cells. After a session, the treated fat looks like a stick of butter because it assumes the shape of the suction cup and needs to be massaged flat again. Cool sculpting can get results, but they’re very subtle. Some people who have come to me for a consultation have said they’ve had Coolsculpting, but were unsatisfied and were now looking for “real” results.

Liposonix is a transdermal (through the skin) ultrasound device. A probe is placed on the skin and ultrasound waves are sent through the depths of the tissues, in theory to melt fat below the skin. Demonstration videos using pig fat and the like look pretty cool. Unfortunately, the results are not all that impressive, from what I have seen. Finally, I have heard that the treatments are painful.

Vanquish is another transdermal device, this time using laser energy to penetrate the skin and melt fat. Again, it seems to work, but results are fairly subtle…so far.

All of these non-invasive technologies have some merit and are very intriguing. But I don’t think we are yet at the point where I would trust one of these gadgets to make a New York City patient happy. So when it comes to non-invasive ways to remove stubborn fat, we’re not there yet. I need to deliver for my patients, and liposuction remains the state of the art.

For best results, choose your surgeon and facility wisely

If you’re having liposuction, it’s important to choose a board-certified plastic surgeon and have your surgery in an accredited surgical facility for best results and the safest care.